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Back to Wellness Chiropractic offers new patient intake forms online that can be quickly printed and completed prior to your appointment! This can save you and your family some time at the office!

Please let us know the history and current state of your health. Do you suffer from nagging low back pain, headaches, and/or colds? How about reoccurring sinus troubles, constipation/diarrhea, or acid reflux? Or do you not have any particular health issues but want to increase your overall health in general? How can we help you? Let us know!

Adult Intake Forms

Child Intake Forms

Infant Intake Forms

Toxicity Questionnaire

Food Intake Journal

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Bring the forms with you to your appointment or conveniently fax them in!


Sign up for our monthly newsletter to keep up on current health issues and news and events in our office!  Click Here to register online!  We look forward to making your experience with our office and website more interactive and rewarding!



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